Tuesday, October 25, 2011

In May of 2004, I had some blood tests done by my doctor. My cholesterol was a bit high, so she recommended that I cut back on saturated fat. I ended up making a lot of changes to my diet then - cut saturated fat significantly (I was logging everything back then, so this was easy to say), cut back on fast food, and ate a lot more whole grains and vegetables at home.

I remembered today that I had a c-reactive protein test back then, and I thought I might have emailed Sally about it at the time, so I searched my Gmail for "CRP" and turned up an email I wrote a year later when I had more tests done. I'm interested in CRP because it is a marker of inflammation, which may be one of the causes of leptin resistance, which may be a major cause of obesity.

Anyway, I now present, for your reading pleasure, this email from 2005.

So basically, all of my numbers have gotten WORSE rather than better,despite my having lost a substantial amount of weight (13% of theweight I had in April, in fact) and changed my diet in all therecommended ways (if not to all of the recommended extents).

In addition, this time I had that Cardio CRP test. I got a 10.7.Here is what the reference numbers are:

Yuck. My doctor wants to have all of this retested in November, andmeantime recommends continued weight loss, exercise, and avoidinganimal fats. (What animal fats? I hardly eat any fucking animal fatsanymore anyway.)

This is kind of freaking me out.

Notice that eating less animal fat, cutting saturated fat from my diet resulted in HIGHER triglycerides (very bad) and slightly worse cholesterol numbers (probably bad), despite the fact that I lost 29 lbs over that time, which would be expected to improve things.

This proves nothing, of course, but unlike most anecdotes, this one at least applies to me specifically.

Friday, October 21, 2011

I thought it would be good to set out my current beliefs about diet, nutrition, the causes of obesity, and so on. They are what guide my (perhaps wacky-seeming) current dietary guidelines. I'd also like to distinguish them from other beliefs with which they might be confused.

Food Reward Hypothesis

I think the food reward hypothesis is the best-supported current idea about why so many of us are overweight and obese these days. The basic idea of this is that we now have the ability to make (in many cases manufacture) foods that are both hyper-palatable (really delicious) and high reward (very tempting/craveable/"addictive" in a loose sense), and that eating such foods causes our bodies to try to keep us at a higher weight than is healthy.

This shouldn't be confused with the "thrifty gene hypothesis," which is the common-sense idea that we evolved to live under the threat of starvation and are going nuts now that food is so plentiful. According to the food reward hypothesis, if our food were still the sort of plain, comparatively unvaried food eaten by our ancestors, abundance itself wouldn't cause overeating.

(Note: I will be linking Guyenet a lot in this post. He is not my only source of information here, but he has informed a lot of my thinking, and seems to have done his homework. In many cases he's the best concise link I can give.)

Conclusion: I should eat simple foods prepared at home.

The Role of Carbs

Books like Good Calories, Bad Calories by Gary Taubes make convincing arguments that overconsumption of carbohydrates, particularly sugar and refined flour, are responsible for the obesity epidemic. Certainly, obesity travels together with insulin resistance (a problem that is all about carbs, and is the fundamental cause of Type II diabetes), and insulin resistance is a big part of what causes heart disease in general.

I honestly don't know what to think about this topic. But what everyone (at least, everyone I'm currently reading) seems to agree on is that if you are insulin resistant, eating a ton of carbs is a bad idea. This is contrary to the official recommendations for diabetes patients (which stress a high-carb, low-fat diet), but I've read enough to convince me that that is bunk; I'll write more below about why.

I've been testing my blood sugar lately, and my fasting morning glucose levels are slightly elevated - not in the diabetic range, not quite in the "pre-diabetic" range, but not where they should be or where they have been in the past either. I have a strong family history of diabetes and I have other signs (like PCOS) of having trouble with insulin resistance.

The dominant hypothesis of the last half-century or so of medical advice has been that overconsumption of fat is what causes obesity and (separately) heart disease. This is why diabetics and overweight people (and, really, everyone) is encouraged to eat a low-fat diet.

It is a fact that you cannot eat a low-fat diet without eating a high-carb diet. Humans can't eat the bulk of their calories as protein (you will get sick if you try, but you'll also find it very hard to try, because you will start very very badly not wanting to eat any more lean meat).

The evidence that high fat intake causes obesity is based partly on common sense (fat has more calories per gram than carbs or protein) and partly on the observation that Americans got fatter and started (perhaps) having more heart trouble around the early part of the 20th century, when (it is believed) we may have started eating more fat.

We also started eating way more sugar and refined flour and packaged products and that sort of thing at the same time, so it's very hard to tease out the effects of fat vs. carbs vs. high-reward foods (vs. unknown other factors, of course). There seems to be very little evidence that eating a high fat diet causes weight gain. Many traditional cultures (Inuit, Masai) eat very high fat diets and are very lean (despite not facing any regular food shortages).

Conclusion: It's OK to eat a high-fat diet.

What about Saturated Fat?

As someone who has lived in our culture, it is very difficult not to believe that saturated fats, especially from meat and animal products, are dangerous. I feel as though I know in my very bones that these types of fats are unhealthy and cause heart disease. This is one of the very strongest messages about food from the medical establishment.

From what I can tell from my reading, it's just not true, or at least, many very large, long-lasting studies designed specifically to support this hypothesis have completely failed to. Now, my reading isn't (can't be) exhaustive and it's possible my sources are looking at the data in a really biased way, but it doesn't seem so to me.

An additional bit of common-sense thinking: for a very long time before agriculture, our human ancestors got most of their fat from animals. Either they ate a very high-carb diet (and probably some did), or they ate a lot of animal fats (definitely some did). It's likely we evolved to be able to handle eating these fats.

Conclusion: It is truly safe and healthy to eat saturated fats, including from animals.

Pre-Western Cultures

The fundamental idea of the paleo and primal advocates is that we should eat the way that our hunter-gatherer ancestors did, rather than the way that our immediate agricultural ancestors did. In other words, rather than relying heavily on grains, legumes, and dairy for our food, we should eat more meat, vegetables, perhaps occasional tubers, berries, nuts, and things like that. We certainly spent a lot more time evolving to eat a hunter-gatherer diet than we have spent evolving to eat grains.

The only populations on the planet today who don't suffer from a lot of heart disease, obesity, diabetes, cancer, and other "diseases of civilization" (periodontal disease, appendicitis, gall bladder disease, etc.) are the ones people used to call uncivilized - small pockets of people living a traditional culture. It is true that they largely lack these health problems even when you adjust for age.

These groups are very different from each other. The Masai have a diet made up almost exclusively of milk, cow blood, and meat. Traditional-living Inuit have a diet that is something like 90% animal fat. On the other side, there are traditional cultures who live very healthy long lives (when they don't die in infancy) on diets composed almost exclusively of yams or sweet potatoes, and others who eat more balanced diets. But in general, my point is that there are very healthy cultures living on high-fat and on high-carb diets. It appears that healthy diets can have a wide range of macronutrient ratios.

What these cultures have in common is that they eat very little refined sugar, very little refined grains, and they don't eat "food that comes in boxes" - highly processed food manufactured to be as delicious and tempting as possible. They eat diets of mostly plain foods, with not a lot of variety by our standards.

It's hard to tease out what aspects of the western diet and/or lifestyle cause all of our problems. Is it the sugar? (There is some evidence that high-fructose foods like table sugar and corn syrup may have especially bad effects.) The comparatively recent introduction of grains to our diets? The refining of those grains and sugars? The even more recently introduced cottonseed, canola, corn, etc. oils (polyunsaturated fats)? Or the excessive variety and deliciousness of the manufactured food products that surround us?

At any rate, if the problem is dietary (as seems likely), then, while we can't say exactly what the problem is, we do know that simple diets of plain, pre-agricultural foods are healthy. (Of course, no food that I eat is actually pre-agricultural. I don't hunt or gather anything myself. But I think we can all agree that grass-fed beef or an apple is more "paleo" than a Big Mac.)

Conclusion: It may help to avoid modern agricultural products like sugar, refined grains (or any grains in large quantities), and seed oils.

Exercise

Exercise decreases insulin resistance and has many other beneficial effects, but I seem currently incapable of incorporating much into my life. If I explained why, I would just be making excuses, so I'll just say it's not a big focus for me right now.

Based on what I've read lately, I do think that high-intensity interval training is way more effective than regular steady moderate-intensity cardio. If I were designing an ideal exercise program, I think I'd go with something like Mark Sisson's recommendations in The Primal Blueprint, which means a good base of low-intensity exercise (walking, slow swimming, jogging if you're much more fit than I am), small amounts of interval training (two or three times a week for 5 or 10 minutes), and regular natural, whole-body strength training (two or three times a week for 30 minutes or so).

Conclusion: I should exercise, but I don't.

I hope this helps to make sense of why I'm doing what I'm doing, or was at least interesting on its own.

I am OK with eating some of the "don't eat" items a couple of times a week in order to eat at restaurants with friends. Other than that, I am trying to make my food at home and keep it relatively simple.

Sunday, October 09, 2011

This morning I hit a new low weight. Overall I've lost 22 pounds since early May, which is pretty awesome. And today is my 7th day of largely eschewing grains and legumes and of keeping my carbohydrate intake between 50 and 100 grams per day.

So what am I eating?

Yesterday I had a fajita chicken salad (w/ cheese, sour cream, and guac) for breakfast, eggs with turnip greens and cheese for lunch, and chicken tikka masala at a restaurant for dinner. I was trepidatious about eating chicken tikka masala without rice or naan. Frankly, it seems a little insane. But I managed it and it was still extremely delicious (though I did crave the naan and rice that were on the table, so that was a little uncomfortable).

Today I got up early, worked for three hours, and then made myself a breakfast of scrambled eggs mixed with tri-color peppers (from frozen), a big chicken sausage link (cut up), and cheese. I cooked this in ghee (clarified butter) and it was extremely delicious.

It's no longer the case that I don't get hungry. I do get hungry. But the hunger is like the hunger of my childhood - it doesn't really interfere with activities. You think "Where's dinner?" but then you can happily go run around some more in the meantime. It's not urgent. (More precisely, it feels urgent, but only intermittently.) I really like this change.

There has been one more change. Before I started losing weight in May, I was taking 150mg of ranitidine for heartburn twice a day - so, 300mg per day total. Eating smaller meals to reduce calories let me drop that to 1 pill per day, so in half. Then I bought some smaller ranitidine pills (75mg each) and was taking two of those a day. Now I am taking at most one of those per day, and some days I don't need any at all. I would love (so much) to stop using heartburn medication, and it seems within reach. Yesterday I didn't take any, not even a single Tums, which is amazing considering all of the spicy, fatty things I ate, which are usually exactly the things to cause heartburn.

Other than the changes to hunger and acid reflux, and the accelerated weight loss, I haven't noticed any changes. I feel good, happy, etc. Most of my meals are very satisfying due to the high fat content. It is sometimes tricky to figure out what to eat, but I've always tended to obsess over what I was eating next anyway, so this has just channeled that into a different direction.

Wednesday, October 05, 2011

Last week's no-wheat experiment went pretty well. It wasn't too hard not to eat wheat (I ended up eating a fair bit of corn tortillas and tortilla chips) and it seemed to cut my hunger a bit. I lost a pound a day for about 4 days in a row and then gained one or two back after that, so that was kind of exciting.

This week I've been reading The Primal Blueprint, and I'm experimenting with completely not eating grains or legumes and keeping my carbohydrate amount between 50 and 100 grams a day, which is the level at which the author of that book claims effortless weight loss will occur.

I'm still eating dark chocolate, having coffee if I want to, and I'm not avoiding things like soybean oil, largely because it's much easier for me to have salad at the school cafeteria if I can have ranch dressing rather than the nutritionally superior olive oil and vinegar type of thing. So I'm still basically eating sugar (which is a grain) and some legumes. Other than that, I haven't (to my knowledge) had anything - no wheat, no rice, no oats, no beans, etc.

It's a sort of radical thing to do, obviously. But it wasn't a huge transition since I'd already been eating no wheat and keeping my carbs low for a week. I haven't noticed any untoward effects this week, while last week I did have some serious crankiness and headaches.

What I have noticed is that I have absolutely no perceptible blood sugar changes. I sort of still get hungry - at least, there is a kind of feeling that grows over time that tells me I should eat something. It's kind of a gaunt or empty feeling. But it no longer seems to carry with it much urgency. (For instance, I had no breakfast today, a small lunch at 10:15, and I was fine not having dinner until 6:30.) And I never have blood sugar crashes, which I frequently did before. That's kind of a big deal.

My weight has been dropping pretty seriously - like about 2.5 pounds since Monday. I'm not recording these new weights yet, since they may settle back down. I'm still tracking everything I eat, and I'm pretty easily creating calorie deficits of 700-900 calories a day basically without trying. (I'm not really trying to limit my food intake.) So that's kind of amazing.

It could be that some of the "this is so easy!" aspects of doing this are basically just me being excited about doing something new. I could get really tired of this and find it just as hard as anything else. It's certainly extreme to not be able to eat virtually anything that normal people eat (sandwiches, pizza, tacos, muffins, fried rice,...). But I'm finding I can eat something at most places I ever go, and that's working for me just fine for now.

If this does prove to be a way to maintain a much lower weight without the extreme effort of resisting eating all the time, I think I would have to choose many extra years of healthy life over the ability to eat these common and delicious foods. So basically if this keeps up, I'd like to keep doing it. We'll see, of course, whether I feel that way in a week or a month or whatever.

It's probable that the weight loss comes more from the effects of low-carb than from avoiding grains and legumes per se. When you don't eat carbs you don't set up part of the insulin cycle that makes you hungry again a few hours later, which is a particular issue for people who are blood-sugar-challenged, like me.

But the advantage of eschewing grains and legumes while doing low-carb is that you don't end up prioritizing a muffin over the day's vegetables. I'm eating tons of vegetables most days, and some fruit as well, plus dark chocolate, plain yogurt, nuts, and other carb-bearing foods. If I were just trying to keep carbs down I think I'd trade some of that for, say, white rice, and that would be less healthy, in general.